“Let me tell you a story,” the county supervisor said.
A man I’ll call Frank was picked up for drunk driving. Frank faced a felony charge. Frank was sent by our local judge to a county-based program funded with a grant. Over the years, the county supervisor helped the county get funding from the Treatment Alternatives and Diversion (TAD) program.
“The drug counsellor asked the man why he drank a quart of vodka a day,” the supervisor told me. The man said, “My teeth hurt.”
Counsellors worked to get Frank BadgerCare, and medical care. They got him to a dentist, who pulled all his teeth. Frank spent two months on antibiotics. He’s now sober and able to do some fishing – something he loves and hadn’t done in years. The supervisor thanked me for my help, saying the TAD program saved money and saved lives.
In county court rooms, judges have alternatives to sending those suffering from mental health and addiction issues to prison. But not all judges and counties are able to use this life changing program. In the current budget, the state funds only a tenth of what is needed to expand TAD statewide. In the alternative I wrote to the Governor’s budget, I showed how to pay for fully expanding the program with the same state dollars by rearranging priorities.
Folks like Frank need treatment, not prison. Our state mental health system is not adequate. As a consequence, law enforcement and prison costs are increasing, as lives are wasted.
For example, the new Secretary of Corrections recently told the Audit Committee seventy percent of Wisconsin inmates suffer from addiction and over eighty percent of women in prison have mental health conditions.
Minnesota has a very different approach to mental health and addiction recovery. Minnesota is called by some the Land of Ten Thousand Treatment Centers. Years ago, the state invested in a community-based mental health and addiction recovery system. Now, with a similar crime rate and similar population, our neighbor to the west has less than half its residents in prison compared to Wisconsin.
The key to helping those with addiction and mental health challenges are community-based resources. For two decades, the state cut or level funded local governments in the “shared revenue” counties and cities received. In addition to facing decreased funding, state officials piled on more requirements with less help.
When the state adds more requirements but no more money, locals describe the combined effect of less money and spending caps as “the vise squeezing counties.”
“Relationships work when they share purpose and responsibility,” a local county health official recently wrote. “The State-County partnership delivering health and human services to Wisconsin residents falls short on many fronts.”
For example, he said, mental health services are coordinated through a system called Comprehensive Community Services. Like the help Frank received, many mental health and addiction recovery services are paid for through Medicaid (MA).
“MA revenues are billed services vulnerable to disallowances [non-payment],” the local official said. “When this occurs, the county provider is responsible for paying funds back.” With mental health care “the State has taken back hundreds of thousands of dollars but refused to provide guidance to counties … the State provides little technical assistance.”
We can and must do better. Wisconsin must treat local governments like the full partners they are in delivering needed mental health services. We must invest in expanding services as the state works with locals to find the best path forward.
To address the struggle families face across our state, Wisconsin must take the Medicaid expansion money from the feds, cover 79,000 additional people with healthcare and use the freed-up state dollars - almost $300 million estimated for this budget – to make a down payment on a community-based mental health and addiction recovery system.
Locals should be at the table when decisions are made. Flexibility is important. One-size does not fit all. Incentivizing local creativity would improve service delivery.
People are suffering. But there is hope. Comprehensive treatment can be available – just like in Minnesota. Wisconsin can become the Land of Fifteen-Thousand Treatment Centers. Now is the time to act to solve the problems of mental health and addiction. This saves lives and saves money.
Memberships
The Agony and Ecstasy of State-Local Blogging
I'm in a session for the Agony and Ecstasy of state and local blogging. Hey - I'm an expert on Agony. Interesting discussions starting about local blogging (as I keep looking at my battery monitor). This is starting late because many of the panel members couldn't find the room. I can understand why.
Some discussion going on about community blogging, real journalism, etc.
I also recently went to two panel discussions about funding the netroots movement, building a network of progressive entrepreneurs.
The Devil is in the Details
Senator Kathleen
Vinehout
“We have a hearing scheduled for this
week,” I shared with a friend. She replied that she thought the
Legislature was not in session and all the bills died. “This is
not a hearing about a bill,” I said. “It is a hearing on an
administrative rule.”
“A hearing on an administrative rule?
What’s a rule?” she asked me.
Just like a hearing on a bill, an
administrative rule hearing is an opportunity for the public to
provide input into the making of policy. Last Thursday, the Senate
Committee on Health, Human Services, Insurance and Job Creation
convened to consider an administrative rule.
Often we hear the saying “the devil
is in the details”. The rule making process is truly the details of
legislation.
When a bill is passed the language is
often broad and the details sketchy. To implement or administer the
new law or program, the Legislature gives the responsible state
agency authority to create an administrative rule. State agencies use
their expertise to develop the rule. When finalized, an
administrative rule has the force of law.
There is a specific procedure agencies
follow to promulgate, or make public, a proposed administrative rule.
This procedure requires public hearings. Rules are sent to
legislative committees for review. The Legislature has final say
over the proposed rule and the power resides with the committee
chair. He or she can call for a vote to send the rule back to the
agency for changes or take no committee action and the rule becomes
law.
I serve on the Health committee and our
public hearing was on a controversial rule setting out specifics
related to the regulation and licensing of mental health clinics.
The hearing provided an opportunity for
public discourse among committee members and mental health
professionals and clinic owners from all over the state.
Testimony on the rule lasted nearly
four hours and committee members learned about many positive aspects
of the proposed rule and several serious flaws.
Many at the hearing testified the
proposed rule would put small mental health clinics and independent
mental health professionals out of business. In a letter to
committee members, the Governor’s Small Business Regulatory Review
Board indicated the state Department of Health Services did not
adequately study the effect of the rule on small clinics and solo
practitioners.
I received many letters from social
workers, other mental health professionals and clinic administrators
in our Senate District. Generally the letters have been critical of
the administrative rule. In some cases, the consequences of the rule
becoming law are dire.
After calling several folks who wrote
me (yes, always remember to put your phone number on your letter when
you write), I sent a letter with the concerns of those in our
district to the committee Chair. He will meet with the agency
responsible for writing the rules.
I sometimes hear of burdensome
regulation. Invariably this regulation was crafted by an agency
during the rule-making process.
When a new law requires creation of
administrative rules, we as elected officials depend on citizens to
let us know if the proposed rule fulfills the intent of the
legislation. This is particularly true if we do not serve on the
committee providing oversight.
The Legislature decision-making is only
as good as the information we have. To make the process work,
citizens must be participants and not just observers. I thank the
nearly 40 people who took time to contact me about this rule. Their
comments were influential in the policy debate.
There is much work to be done and we
each have a critical role to play. Together we can continue to make
a difference.
Concerned about administrative
regulations? Let me know! Write Senator Kathleen Vinehout at the
State Capitol P.O. Box 7882 Madison, Wisconsin 53707-7882 or
877-763-6636 (toll free).
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